Malaria, the multilayered disease transmitted by Anopheles mosquitoes, has vexed human societies for millennia. However, the recent story of malaria prevention reflects fulfilled promises, intensified commercial rivalries driving better products in shorter timeframes, global partnerships, and growing hope that we could soon achieve global malaria control and even eradication. In this article, I recap recent advances in malaria prevention, the partnerships driving them, and the prospect of controlling malaria globally.
Recent Progress in Malaria Prevention
1. Increased Access to Insecticide-Treated Nets (ITNs)
ITNs remain the most effective malaria prophylactic, and in the past decade, their availability and use have increased significantly.
Global Distribution: Over the past decade, more than 1 billion ITNs have been distributed worldwide. In many endemic areas, this widespread distribution has correlated with dramatic reductions in malaria incidence.
Case Study: ITNs in Sub-Saharan Africa
Large-scale distribution of ITNs has had a significant impact. In sub-Saharan Africa, large-scale distribution campaigns have led to steep declines in malaria cases in countries such as Kenya and Nigeria. In Kenya, the use of ITNs has been linked to a 70 percent reduction in malaria over the past 10 years.
2. Expanded Use of Indoor Residual Spraying (IRS)
Indoor residual spraying or IRS involves spraying household walls, with the insecticide distributed in the house through subsequent mosquito bites and as mosquitoes move around. Stepped-up IRS involves the vegetation in and around the garden that is associated with malaria transmission. However, there have been some recent advances in IRS.
Better Formulations of Insecticides: New insecticide formulations that improve child survival include enhanced versions of the widely used insecticide DDT, as well as newer chemical agents like deltamethrin and permethrin. These agents now support effective and cost-efficient insecticide-based interventions, such as indoor residual spraying (IRS), to combat insecticide-resistant mosquito strains that reduce the effectiveness of IRS.
Case Study: IRS in Zambia
New insecticide classes have helped overcome these types of resistance problems, too, and IRS is effective and perhaps even more so than expected in high-burden settings. Returning to Zambia, IRS has been used with success in malaria control.
3. Advancements in Malaria Vaccines
The development of malaria vaccines represents a groundbreaking achievement in disease prevention.
Mosquirix, short for RTS, S/AS01 Vaccine Another recent clinical trial has involved an entirely different experimental malaria vaccine, which inspired a hopeful headline from Scientific American this spring: ‘The World Health Organization Approves a Malaria Vaccine’. This ‘world-first’ approval was for Mosquirix, short for RTS, S/AS01 Vaccine, the first malaria vaccine to complete all three phases of clinical trials. (Mosquirix had already received licensing for use in Ghana, Kenya, and Malawi years earlier.) Pilot programs in Ghana are currently using the RTS, S vaccine for children under five, and early results suggest that it has significantly reduced severe malaria cases and hospital admissions.
Case Study: Vaccine Rollout in Ghana
Pilot programs in Ghana are currently administering the RTS,S vaccine to children under five, and early results indicate a significant reduction in severe malaria cases and hospital admissions. Finally, we might just have a vaccine at our disposal to help us beat the scourge of malaria.
4. Innovations in Diagnostic and Treatment Tools
Advancements in diagnostic and treatment tools have further bolstered malaria prevention efforts.
Rapid Diagnostic Tests (RDTs): More accurate and timely diagnosis of malaria following enhanced RDTs add accuracy and speed to diagnosis, and suggest an optimal cure. Newer tests increase the sensitivity and ability to detect multiple strains of malaria.
Case Study: RDTs in Myanmar
These rapid diagnostic tests (RDTs), developed by Medical Care Development International, another NGO that focuses on research and development, are much more accurate than the previous RDTs used in the country, especially when deployed in rural areas of Myanmar. The advanced RDTs also allow better case management, thus relieving the suffering associated with malaria, and help to rapidly identify and treat individuals with the disease, which reduces the risk of transmission.
Collaborative Efforts Driving Progress
1. Global Partnerships
Efforts to combat malaria have been significantly bolstered by global partnerships.
- The Global Fund: The Global Fund to Fight AIDS, Tuberculosis and Malaria has committed more than $3 billion to support malaria prevention and control. ITN distribution, IRS programs, and malaria research have been financed by its support.
- World Health Organization (WHO): Technical guidance that drives policy; coordinates international efforts; sustains member states in controlling malaria; global leadership works to coordinate individual efforts.
Case Study: The Malaria Elimination Initiative
On the ground, there are promising developments too. In recent years, malaria cases have dropped in countries like those in Southern Africa, thanks to a partnership running from national governments through to the WHO and the Bill and Melinda Gates Foundation, called the Malaria Elimination Initiative, devoting billions of dollars to innovative technical approaches and cross-border cooperation to reduce and eventually eliminate malaria from the tropics.
2. Regional Cooperation
Cooperation between regions helps to prevent malaria wherever borders are shared.
The Elimination 8 Initiative: Eight countries in Southern Africa join in a common effort to eliminate malaria. The Elimination 8 Initiative promotes transnational surveillance, joint interventions, and cross-border resource sharing to eliminate malaria.
Case Study: The Mekong Malaria Elimination Project
Countries including Thailand, Cambodia, and Laos in the Greater Mekong Subregion have worked together in recent years through a program called the Mekong Malaria Elimination Project. They have reduced malaria cases substantially and developed new strategies to combat drug-resistant variants of malaria.
3. Community Engagement
This is crucial in ensuring the success of malaria prevention programs.
Community Health Workers (CHWs): CHWs are critical for the timely delivery of malaria prevention services, education of the community, and early treatment. Investments in training and supporting CHWs enhance the beneficial impact of malaria interventions.
Case Study: CHWs in Ethiopia
Subsequently, Ethiopia has utilized community health workers (CHWs) to deliver insecticide-treated nets (ITNs), conduct malaria tests, and provide medicines, reducing malaria incidence and improving other health outcomes in rural communities.
The Promise of a Malaria-Free Future
1. Ongoing Research and Development
Research is still game-changing in discovering new ways to prevent and treat the disease. Areas of common focus include:
- New research is hybrid health: into developing better malaria vaccines, with broader coverage and longer-lasting protection.
- New Insecticide Classes and Vector Control Tools: by finding new insecticide classes and vector control tools, we can create new ways to combat disease that are effective despite resistance, and that might be more effective in other ways.
Case Study: Gene-Editing Technologies
Gene-editing technologies – such as CRISPR – are being investigated for their ability to modify mosquito populations and decrease malaria transmission. The promise of these new vector-control measures is truly revolutionary.
2. Commitment to Global Elimination Goals
The political will to end malaria is stronger than ever: for example, the WHO’s Global Technical Strategy for Malaria 2016–2030 promises to reduce malaria cases and deaths by 90 percent by 2030. The strategy includes universal coverage of prevention, rapid diagnostic testing and treatment, and strong health systems.
Case Study: The Zero Malaria Starts with Me Campaign
The most recent campaign, “Zero Malaria Starts with Me,” calls on communities, governments, and organizations to champion malaria prevention efforts. In addition, averting malaria is a collective responsibility, and this initiative has been launched at the community, country, and enterprise levels, emphasizing the importance of collaboration in combating this disease. Furthermore, by fostering a sense of shared commitment, the campaign aims to mobilize action and drive meaningful change in malaria prevention. Ultimately, this coordinated effort highlights that each individual and group has a crucial role to play in achieving a malaria-free future.
With new developments in prevention, concerted efforts, and strong community involvement, the fight against malaria is gaining ground, and for the first time in many years, there is much to be optimistic about. Access to insecticide-treated nets (ITNs), advancements in vaccine research, and innovative diagnostic tools are contributing to a comprehensive approach to malaria prevention. This holistic strategy offers renewed hope for significantly reducing malaria’s impact in the years to come. International cooperation and community involvement are ongoing, both on a global and regional front while further research promises more for the future.
In the coming years and decades, if we build on these successes and overcome new challenges, we have the opportunity to make the goal of a malaria-free world a reality. And with continued effort, innovation, and international action, a malaria-free future is, at last, a real possibility.
